Changes affecting NHS Dental Epidemiology in England

1. Changes affecting NHS Dental Epidemiology in England Gill Davies BASCD NHS Epidemiology Co-ordinator

2. Key changes • Arrangements to support compliance and consistency • National Protocol • Consent • Dealing with this in preparation • Afterwards • Lighting • Change of primary sampling unit • Larger frames • Mismatches

3. Current issues identified by Tony Jennerregarding dental epidemiology in England • Lack of direction • Lack of consistency • No performance management • Lack of quality control • Not linked to NHS Public Health Intelligence Strategy

4. Developments • National Public Health Information Strategy • North West Public Health Observatory • Lead PHO for Oral Health in APHO • The Dental Observatory • Undertakes coordinating function in the North West • Strategic Health Authorities

5. Proposed Process • Supporting Directions to NHS DH • Programme specification NHS • Programme advisory group BASCD NHS DH

6. Proposed Process • Performance management cascadeSHA • Protocol design TDO NWPHO • Training TDO commisssion • Calibration TDO commission

7. Proposed Process • Appoint regional coordinator PHO SHA • Regional training/ calibration RCs • Data collection PCT • Data analysis and QA TDO Further analysis and links NWPHO • PHO data sets NWPHO

8. Proposed Process • Dissemination/Conference TDO NWPHO • Data for compendium NWPHO • Data for APHO profiles NWPHO • Paper for CDH DHSRU

9. Key changes • Arrangements to support compliance and consistency • National Protocol • Consent • Dealing with this in preparation • Afterwards • Lighting • Change of primary sampling unit • Larger frames • Mismatches

11. CDs for each PCT • National Protocol • National SP II Format • Reporting form with Excel support • Questionnaire for reporting consent experiences

12. Key changes • Arrangements to support compliance and consistency • National Protocol • Consent • Dealing with this in preparation • Afterwards • Lighting • Change of primary sampling unit • Larger frames • Mismatches

13. National Protocol - consent Principles Local methods of collection Suggested letter with form Tracking sheet to help schools Importance of recording information on all children approached

14. Tracking table

15. Data collection - coding for sample and consent • Child identity number |__|__|__|__|__|__| 9. Month/Year of birth |__|__|__|__|__|__| • Postcode |__|__|__|__| |__|__|__| • Sample group code |__| 0 - Main BASCD sample (co-terminous) 1 - Additional sample A 3 - Additional sample B 4 - Additional sample C 5 - Additional sample D 6 - Additional sample E • Consent status |__| 0 - form not returned 1 - consent refusal 2 - positive consent provided 13. Examination type |__| 0 - Main 1- repeat 2 - training 3 - absent 4 - child refused

16. Dealing with consent bias • Centralised assessment of samples • Centralised production of synthetic estimates • Comparison between previous estimates and new ones • Reporting of local outcomes – questionnaire • Reporting to Dept Health • RCT in North West

17. Key changes • Arrangements to support compliance and consistency • National Protocol • Consent • Dealing with this in preparation • Afterwards • Lighting • Change of primary sampling unit • Larger frames • Mismatches

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19. Key changes • Arrangements to support compliance and consistency • National Protocol • Consent • Dealing with this in preparation • Afterwards • Lighting • Change of primary sampling unit • Larger frames • Mismatches

20. 4. Sample The primary sampling unit will be Local Authorities and samples also need to be taken to produce estimates for PCTs. In most cases the Local Authority and PCT will be coterminous so one sample will suffice. In the minority of cases where the PCT and LA are not co-terminous careful consideration of the geographic boundaries and populations within them should be undertaken to ensure that sampling produces the estimates for Local Authorities and for Primary Care Trusts.

21. 4.1 Survey population The survey population is defined as all those children attending maintained schools within the Local Authority who have reached the age of five, but have not had their sixth birthday on the date of examination (Excluding special schools). A minimum sample size of 250 children is required per Local Authority and per PCT, from a minimum of 20 schools. This is unlikely to produce a sufficiently large sample to facilitate local planning for many PCTs, in which case larger samples will be required.

27. Table in Protocol showing relationships between LAs and PCTs

28. http://www.dh.gov.uk/en/News/DH_4135088

29. Data Collection – coding of geography Appendix L – Data Collection Form • LA code |__|__|__|__|__|__| 2. New PCT code |__|__|__|__|__|__| • Old PCT code |__|__|__| • Examiner__________________________ 5. School name _________________________________ 6. School postcode |__|__|__|__| |__|__|__| 7. Date of examination|__|__|__|__|__|__|